APPROVAL= anything is possible
When I was on the phone a couple of Fridays ago at Hunter's six year old well check, I was emotionally drained from the rough week of behaviors that Paige's strep unleashed with Hunter. I had been on the phone for two hours (and if you know me, I rarely get on the phone during the day unless it is naptime or a necessity). I had found out that morning that our request for IVIG had been closed and a new case needed to be opened (many factors involved- too long and complex to explain); which equaled starting over from square one.
I was so frustrated. The clock was ticking- we were two weeks away from his next scheduled procedure and after attempting a true, solid approval since last July, I wasn't about to have to start over.
We had been assigned a case worker by our insurance due to the time sensitivity factor and also the complex factors involved in his treatment recommendations. Dr. G had warned us that they would deny the IVIG the first time they submitted it (post the first three rounds), but that he had enough positive data to ensure that an approval would be made. So after denying the initial request, our Dr's office submitted their clinical information and we hoped for an "urgent" answer. To make a long story short, after working with several employees, both from the insurance as well as the specialty pharmacy, I ended up on the phone for a total of three and a half hours until I received a phone call at 4 PM that day that the prescription had been approved.
The next week, I received this letter in the mail.
APPROVED..
Not by a compassionate HR department.
Not in a "trial" period.
A real, true, Medical Director approved decision. He overturned the denial and accepted the appeal.
I cannot explain the triumph that you feel when you overcome so much adversity...when you go from hours of phone calls and appeals and a stack of letters like this:
where one by one, they tell you that you are denied.
that your appeal was rejected.
that it is over.
However, it wasn't over. As far as I was concerned, it never even started.
Tell me I can't do something, and I will try even harder. My previous triathlon coach had told me that I needed to join his Half-Ironman training program in order to complete my first long-distance race six years ago. At the time, I couldn't a)afford the program b)have the time flexibility to make all the workouts. I joined the group for a final bike before the race, and as I brought up the rear (I had fractured my elbow two months prior and had lost 6 weeks of training), he told one of my friends, "She isn't going to finish that race. There is no way she can complete the magnitude of the hills in CA."
I not only completed that first race, but I have gone on to complete four more half-Ironmans and a fifty-mile triathlon last weekend- on my own.
I'm not writing about triathlons to toot my own horn...merely to demonstrate the power of facing adversity. Some may call it hard-headed...but I call it unending perseverance.
I feel that throughout my life, there have been so many roadblocks; we all have them. People, situations, decisions, opinions, transitions, illnesses...many different factors trying to break us down. My wise riding partner told me that instead of getting angry about the negativity in her life (she was talking about people in her life at this point), she prays for them. Instead of getting angry, or resentful, she prays for them...and somehow, the ill feelings start to dissipate.
Pray is not the answer for it all. Taking out my daily devotional doesn't grant me a "pass" on the hard days.
Prayer gives us something to believe in...
.... and belief gives us hope...
...hope gives us strength...
...and strength gives us perseverance.
When I started blogging a couple years ago, my first blog entry compared this journey to a triathlon...a race that requires everything that prayer encircles- believing in yourself, strength to compete, and perseverance to finish.
As I said earlier, this race is just getting started. Even though we have had some major victories, as well as roadblocks along the way, it is way to early to stop believing, stop hoping, stop persevering.
Anything is possible...
I was so frustrated. The clock was ticking- we were two weeks away from his next scheduled procedure and after attempting a true, solid approval since last July, I wasn't about to have to start over.
We had been assigned a case worker by our insurance due to the time sensitivity factor and also the complex factors involved in his treatment recommendations. Dr. G had warned us that they would deny the IVIG the first time they submitted it (post the first three rounds), but that he had enough positive data to ensure that an approval would be made. So after denying the initial request, our Dr's office submitted their clinical information and we hoped for an "urgent" answer. To make a long story short, after working with several employees, both from the insurance as well as the specialty pharmacy, I ended up on the phone for a total of three and a half hours until I received a phone call at 4 PM that day that the prescription had been approved.
The next week, I received this letter in the mail.
Not by a compassionate HR department.
Not in a "trial" period.
A real, true, Medical Director approved decision. He overturned the denial and accepted the appeal.
I cannot explain the triumph that you feel when you overcome so much adversity...when you go from hours of phone calls and appeals and a stack of letters like this:
that your appeal was rejected.
that it is over.
However, it wasn't over. As far as I was concerned, it never even started.
Tell me I can't do something, and I will try even harder. My previous triathlon coach had told me that I needed to join his Half-Ironman training program in order to complete my first long-distance race six years ago. At the time, I couldn't a)afford the program b)have the time flexibility to make all the workouts. I joined the group for a final bike before the race, and as I brought up the rear (I had fractured my elbow two months prior and had lost 6 weeks of training), he told one of my friends, "She isn't going to finish that race. There is no way she can complete the magnitude of the hills in CA."
I not only completed that first race, but I have gone on to complete four more half-Ironmans and a fifty-mile triathlon last weekend- on my own.
I'm not writing about triathlons to toot my own horn...merely to demonstrate the power of facing adversity. Some may call it hard-headed...but I call it unending perseverance.
I feel that throughout my life, there have been so many roadblocks; we all have them. People, situations, decisions, opinions, transitions, illnesses...many different factors trying to break us down. My wise riding partner told me that instead of getting angry about the negativity in her life (she was talking about people in her life at this point), she prays for them. Instead of getting angry, or resentful, she prays for them...and somehow, the ill feelings start to dissipate.
Pray is not the answer for it all. Taking out my daily devotional doesn't grant me a "pass" on the hard days.
Prayer gives us something to believe in...
.... and belief gives us hope...
...hope gives us strength...
...and strength gives us perseverance.
When I started blogging a couple years ago, my first blog entry compared this journey to a triathlon...a race that requires everything that prayer encircles- believing in yourself, strength to compete, and perseverance to finish.
As I said earlier, this race is just getting started. Even though we have had some major victories, as well as roadblocks along the way, it is way to early to stop believing, stop hoping, stop persevering.
Anything is possible...
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